Leading the delivery of brand specific market access analytical insights in response to specific market access issues/trends to drive data driven decision making.Leading the development of GPO, Specialty Pharmacy, Health Plan and PBM contracting strategies for launch brands across market access channels through advanced modelling techniques and informing financial projections based on pricing and contracting strategies.Understanding the impact of utilization management, tiering and medical policy impact on overall demand, line of therapy and co-pay support.Conducting investigative analytics to validate and/or quantify market phenomenon related to competitive or customer tactics.Identifying value drivers that guide clinical data development and value positioning.Leveraging a strong understanding of syndicated and proprietary data, data science and modeling techniques to synthesize insights into compelling narratives.Managing suppliers and stakeholders, leading external analytics to deliver compelling learnings, and formulate strategies appropriate for the issue at hand.Leading the communication of market access insights to leadership.

Monitors employee job performance to ensure that all necessary tasks are completed in accordance with specified client-specific service level requirements. Conducts daily monitoring of employee production to ensure teams meet or exceed performance standards and achieve quality control measures. Assist the Area Leader with various training initiatives necessary to prepare the Reimbursement Specialist, Seasonal to meet all performance benchmarks. Provides day-to-day instructions to team members on job responsibilities. Act as subject matter expert on HUB process, payer process, and Specialty Pharmacy process for Care Managers and client. Assist with the hiring process and development of program training documents. Proactively identifies program issues and proposes ways in which to address these challenges. Maintains positive rapport with internal and external customers. Assist in the development of project task plans and standard operating procedures. Analyzes quality reports for trends and gives recommendations. Work with upper management on special projects overcome/prevent barriers of access to therapy for the patients.

Oversee the performance and performance metrics for a team of 25-40 case managers within the call center regrading all aspects of the reimbursement process for supported products/services. Work closely with the Program Director and the Executive Management Team to meet departmental goals and performance. Plan, review and optimize workflows within the call center. Track and monitor teams’ performance metrics to ensure case managers are meeting adherence standards and guidelines. Develop plan of action to ensure all team members are adhering to company polices, standards and guidelines. Ensuring employee training and quality of work is always above expectations. Oversee teams’ accurate completion of data entry, benefits, funding, free drug dispensing and other related daily tasks to ensure compliance with SOP’s and SLA’s. Ensure the KPI’s are aligned with daily activities and tasks. Schedule and delegate workload among team members, as needed to accommodate vacation and illness. Manage your team member’s workloads to effectively manage cost and reduce overtime. Audit and verify team members work to ensure information accuracy. Work cross-functionally with dedicated QA Trainers for optimal training, on-boarding, and continuous development of staff. Answer staff and customer questions and recommend corrective services to address customer complaints. Work with call center leadership to identify improvements and provide plan of action on improvements. Complete all employee documentation in a timely manner, including annual performance appraisals.

Collects and reviews all patient insurance benefit information while following organizational guidelines. Aids physician office, staff and patients to complete and submit all necessary insurance forms and program applications. Initiated and monitored prior authorizations based on the payer and medical policy while adhering to HIPAA, state and federal guidelines. Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers. Provides exceptional customer service to internal and external customers; resolves any customer requests in timely and accurate manner; escalates complaints accordingly. Reports any reimbursement trends/delays to supervisor. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate actionServe as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner. Effectively and accurately completed benefit verifications and was a payer trending expert. I was also responsible for prior authorization, predetermination, and referral preparation and status monitoring as requested by the health care provider. I triage prescriptions to the contracted specialty pharmacy and conducted follow up calls to obtain/confirm delivery/refill status. Trained on various immunology products, worked with high profile sites, provided weekly status updates, managing site needs above and beyond standard responsibilities.As a Reimbursement Counselor I was responsible for various reimbursement functions including patient assistance and copay programs, payer knowledge, contractual adjustments, correspondence, appeals. Educating physician office staff on the use of our client's patient assistance and call center support services. Identifying alternate funding/financial assistance programs Worked independently.

Responsible for the management of defined accounts in a specified geographic region. Responsibilities also include ensuring optimal access & creating understanding of access services & program support, managed daily activities that support appropriate patient access to the client's products in the provider offices & worked as a liaison to other patient assistance and access support services offered by the clients.Benefit Verification SpecialistPayer expert for defined geography & able to communicate changes to key stakeholders in a timely manner. Effectively & accurately completed benefit verifications & was a payer trending expert. I was also responsible for prior authorization, predetermination, and referral preparation and status monitoring as requested by the provider. Triaged prescriptions to the contracted specialty pharmacy, conducted follow up calls to confirm delivery/refill status. Trained on various immunology products, worked with high profile sites, provided weekly status updates, managed site needs above and beyond standard responsibilities.Reimbursement Counselor Responsible for various reimbursement functions including patient assistance & copay programs, payer knowledge, contractual adjustments, correspondence, appeals. Educating physician office on the use of the client's patient assistance & call center support services. Identifying alternate funding/financial assistance programs. Worked independently, making good business decisions strategically, & possessed the ability to respond to business needs quickly & accurately in order to achieve departmental goals & objectives. Responsible for identifying & analyzing trends/issues & effectively communicate to management the potential impact on the department while providing optimal customer service & reimbursement support to internal &external customers.